Modern parodontosis-therapy with ozone – biological, pain-free, non-invasive
Application report by Dr. med. Dent. Dominique Heidle, Hamburg, Germany Parodontosis (better: periodontitis) is, from the dental point of view, well on the way to become the common disease no. 1. Quite often the attending dentist faces the problem, that regardless of extensive mechanical treatment, which is frequently applied in combination with chemical therapeutics (ointments, gels, chips, threads, systematic antibiosis), no sufficient long-term success can be achieved. Therefore patients are surprised – and rightly so -, when often after a short period this very unpleasant “pocket-treatment” has to be carried out again. Searching for new and improved ways of treatment, which offer better prospects of lasting success, I came some time ago across the medical device OzonyTronX and the ozone therapy. For nearly a whole year now I have been treating successfully with this modern biological remedy and disinfectant. On the basis of two very impressing cases I would like to describe now the possibilities of ozone.
The first case is about a form of periodontitis in the widest sense, which is very difficult to control – periimplantitis.
About ten month ago a then seventy-two-year-old patient came into our practice. As far as the anamnesis is concerned, he reported, that about five years ago he had get two implants in region 34 and 36. About three years after the implantation first symptoms of periimplantitis appeared at the implant 34. Since then, according to his own statement, he was a long-term guest of his attending dentist. The region in question ached permanently; the gingival was swollen and bled. The whole range of treatment possibilities was exhausted, however without lasting success. When he was told, that the implant, though clinically tested, should be removed, he decided to ask for a second opinion. Fig. 1 shows a detail of a panoramic radiograph, which was taken in our practice (digital photo of a conventional radiograph).
Clinically distinctive characteristics of inflammation were identifiable. The gingival was thick and deeply red; the circular depth of probing was 12mm (fig. 2) combined with bleeding and emptying of pus.
Modern periodontitis therapy
After a lengthy information of the patient we have decided to curette carefully the pockets first under local anesthesia in order to permit a sufficiently deep penetration of the OzonyTronX PA-probe (OzonyTronX®, Mymed GmbH, Töging am Inn, Germany) and to reduce a bit the granulation tissue. After extensive irrigation of the pocket with hydrogen peroxide (fig. 3) followed an insufflation of the pocket with ozone for 40 sec (fig. 4). The patient experienced the treatment as pain-free. We repeated the treatment with ozone twice again in intervals each of one day. However, we then did without a repeated curettage and only executed irrigation with H2O2 because this increases the microbicidal potency of ozone (Sommer et.al 2004). Fig 5 shows the situation four weeks after the first appliance. The inflammatory free gingival conditions are impressing, no bleeding while probing. But most of all, a joyfully beaming patient tells us, that after a long time he is finally free of pain again and also able to chew on that side.
The end of a period of suffering
Now the patient is with us for periodical follow-up examinations and even after nine month the situation was stable and free of inflammation. This, in my opinion, very impressing example of the appliance of ozone shows the astonishing possibilities of this “remedy”. Carefully, and at the same time extremely effectively we could help a person who had to live through a long and sometimes very painful story of suffering.
Before describing further examples out of my daily practice, I want to illustrate – quite shortly – the effect of ozone on the tissue. Already in 1891, i.e. seven years before the description of the molecular formula of ozone (O3), the bactericidal effect of this
“pungently smelling gas” was detected. In dentistry it was applied for the first time in 1934 in order to treat periodontitis, dental granulomas and other sources of inflammation. Today we know that ozone is not only highly effective against bacteria, but as well and to the same degree against viruses and oral fungi. Responsible is the highly reactive oxygen (in status nascendi = state of formation) which is created both during the formation and the decay of ozone. And here lies one of the strong points of the OzonyTronX, which uses both effects (Schneider, H.-G., DZW 15/04).
That we can achieve with ozone also long-term effects, which go far beyond the mere bactericidal effect, is due to a number of secondary effects. To this category belong a better rejection of free radicals, and induction of the formation of pro- and anti-inflammatory cytokines and of growth factors, an improvement of the microcirculation and a stimulation of the epithelial regeneration (Filippi 1997 and 2000, Bocci 2004 and 2005).
After this short account of history and mode of action of ozone I return to my description of a second clinical case.
A female patient with a profound marginal periodontitis, who had been already to my attendance for a longer period, consulted me one morning in my practice. Despite of a treatment for parodontosis, a recall-interval of three month and a very good domestic oral hygiene the patient suffered from permanently reoccurring acute inflammation of the pockets. And she did so that day. It was her explicit will, against my recommendation, to renounce the application of antibiotics. That day I was in the lucky position to offer her ozone. Her problem was an acute inflammation of a 9mm-pocket on tooth 36 which was shortly before forming an abscess. After irrigation with H2O2 we used in this case the capillary probe (KP) of the OzonyTronX with a very thin and flexible canula (fig. 6). With this probe it is very easy to bring the ozone down to the fundus of the pocket.
Pain-free within short time
The next day the patient could report that she had been nearly pain-free within few hours. As a result we treated the pocket with the PA-probe on the same and on the following day and recommended to the patient a generalized ozone therapy. This therapy was carried out six month ago and since then the patient escaped any further acute phase of inflammation. For a longer time already we have been applying in our practice within the context of the periodontitis therapy the method of the “full mouth therapy”. After an initial anti-infective hygiene-phase we conduct the actual PA-treatment of all four quadrants within 24 hours. It is the objective to reduce all residents in the pockets and to extinguish those with pathogenic potential (Rateitschak, Parodontologie, Thieme; 2003). This is also called the “full mouth disinfection” – FDIS. With that procedure the use of ozone proved to be helpful in two respects. On the one hand we achieve a very good and reliable reduction of germs and on the other hand the phase of healing after this often “brutal” but pain-free action is distinctively shortened. As a conclusion we can say, that thanks to ozone even grave parodontological problems can be treated carefully but effectively.
Fig. 2 pocket probing
Fig. 1 panoramic radiograph
Fig. 3 irrigation with hydrogen peroxide Fig. 4 OzonyTronX PA-probe
Fig. 5 situation after four weeks Fig. 6 application of the fine KP-probe